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Varicose Veins – Duplex
To be completer by the Ultrasound Technician
Submitted values will be presented to the Vascular Surgeon as non-editable report.
Step
1
of
2
50%
Departmental Duplex Findings
SFJ competence / reflux
SFJ Right
Right
SFJ Left
Left
GSV competence / reflux
GSV Right
Right
GSV Right Size
GSV Left
Left
GSV Left Size
SPJ
SPJ Right
Right
SPJ Left
Left
SSV competence
SSV Right
Right
SSV Right Size
SSV Left
Left
SSV Left Size
Deep system competence / patency
Deep system competence / patency Right
Right
Deep system competence / patency Left
Left
Other comments
Clinical Examination / Classification
C0 - no visible or palpable signs of venous disease
C0 Right
Right
C0 Left
Left
C1 - telegiectasia or reticular veins
C1 Right
Right
C1 Left
Left
C2 - varicose veins >3mm
C2 Right
Right
C2 Left
Left
C3 - oedema
C3 Right
Right
C3 Left
Left
C4a - pigmentation or eczema
C4a Right
Right
C4a Left
Left
C4b - Lipodermatosclerosis or atrophie blanche
C4b Right
Right
C4b Left
Left
C5 - healed venous ulcer
C5 Right
Right
C5 Left
Left
C6 - active ulcer
C6 Right
Right
C6 Left
Left
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